Section 1

Social Service Agencies 121 Preliminary 1. Citation 2. Interpretation. Minimum Operating Requirements 3. Capacity and staff/resident ratio. 4. Failure to meet minimum standards. 5. General administrative requirements. 6. Minimum staffing requirements. 7. Minimum requirements for the protection of residents. 8. Residents’ rights. 9. Residents’ funds. 10. Minimum operating policies. 122 Social Service Agencies 11. Records. 12. Relationship of operator and families. 13. General minimum requirements of the physical environment. 14. Infection control program. 15. Provision of bedding facilities for rest. 16. Minimum programming requirements. 17. General health precautions to be observed by operators. 18. Nutrition. 19. Cleanliness of bedding material to be maintained. 20. Personal appearance and hygiene. 21. Personal articles. 22. Animals. 23. Medical precautions and procedures. 24. Medication and training. 25. First aid kit. 26. Minimum requirements for homes. 27. Minimum counselling requirement. 28. Death and dying. 29. Disaster management. Social Service Agencies 123 30. Fire precaution. 31. Crisis management. Miscellaneous 32. Offences and penalties. 33. Commencement. 124 Social Service Agencies (Gazetted 2nd February, 2008.) Preliminary 1. These Regulations may be cited as theInterpretation. 2. In these Regulations, unless the context otherwise requires“Act” means the Social Service Agencies Act; “applicant” means a prospective operator, person or entity who or which has duly submitted an application for the registration of a home for older persons pursuant to these Regulations, and the word “application” shall be construed and applied accordingly; “assistant” in relation to the operation of the home for older person, means any person who assists the provider of the home for older persons in caring for its residents; “authorized representative” means any person duly authorized by the Ministry to act, for the purposes of these Regulations, on its behalf; Social Service Agencies 125 “capacity of the home for older persons” means the number of resident the home is licensed to take care of at any one time; “Department” means the Department of Human Services; “facility” means a home for older persons; “home for older persons” means the entirety of the premises of a 24 hour facility where residential care services are provided for five or more full time residents as identified in the licence issued pursuant to the Act; “individual care plan” is the identification of the care needs or special needs of an older person determined by the operator, family or concerned individual or person, for any given period of time in care; “licence” means a licence to operate as a home for older persons issued to a successful applicant by the Registrar pursuant to section 9 of the Act; “long term plans” refers to institutionalized elder care by direct care providers; “Minister” has the meaning assigned to it in section 2 of the Act, and “Ministry” shall be construed accordingly; “older person” means a person who is of or above the age of sixty years; “operator” in relation to a home of older persons, means any person, group of persons, partnership, association, organization, unincorporated entity, corporate entity, institution, or agency, whether public or private, who or which has been issued a licence to operate a home for older persons pursuant to the Act and these Regulations; 126 Social Service Agencies “provider” in relation to a home for older persons, means the primary person responsible for the day-to-day operations of the facility; “Registrar” means the Registrar of Social Agencies appointed under section 3 of the Act; “resident” means a person who is residing or has enrolled to reside in a home for older persons; “residential services” means services, not including skilled nursing care, provided at a home for older persons that contribute to the overall welfare of the residents while under the care and supervision of the operator; “respite care” means short term care that is needed in order to maintain the health or safety of the patient or to provide temporary relief from care giving duties to a primary caregiver who is usually a family member; “special incident” means any non-routine occurrence that has an impact on the care, supervision or treatment of a resident or residents, including but not limited to, suicide attempts, injuries requiring medical treatments and, allegations of abuse, neglect or abusive treatments; “staff” means all persons employed by the home for older persons; “staff/resident ratio” in relation to the home for older persons, means the ratio of the maximum number of residents under the direct supervision of the provider or assistant at any one time. Social Service Agencies 127 Minimum Operating Requirements 3.–(1) The Ministry shall determine the capacity of each home for older persons under these Regulations after considering the space in the facility and the category of the facility, if specified. Special care shall be taken in determining the residential capacity of the facility where the facility is catering for residents with special needs. Capacity and staff/resident ratio. (2) The Ministry, in consultation with the operator, shall determine the staff/resident ratio for every home for older persons, provided that the staff/resident ratio shall not exceed five residents for each assistant with a minimum of two staff day and night. Special care shall be taken in determining of two staff day and night. Special care shall be taken in determining the staff/resident ratio where residents with special needs are involved. The operator of a facility shall forthwith report any changes in the staff/resident ratio to the Ministry. 4.–(1) Where families of residents of a home for older persons recognize or are duly informed that the operator of the facility is failing to meet the minimum operating standards for such a facility as provided in these Regulations, the persons shall report such failure to the Registrar or to the Ministry. Failure to meet minimum standards. (2) Subregulation (1) shall not be read and construed as limiting the Registrar’s powers to independently investigate complaints of failure to meet minimum operating requirements by an operator brought to his attention by persons other than the families of residents of the homes for older persons. (3) Where the Registrar comes to the conclusion, after duly investigating complaints made under this Regulation, that the operator of a home for older persons, has failed to meet the 128 Social Service Agencies minimum operating standards required under these Regulations, he may, depending on the seriousness of the failure, either– (a) warn the operator in writing to forthwith comply with the minimum operating standards, pointing out the areas which the operator should improve in order to comply with these Regulations; or (b) suspend the licence for a period not exceeding six months, and notify the operator to comply, within that time, with the minimum operating standards; or (c) cancel the licence. General administrative requirements. 5.–(1) The operator of a home for older persons shall ensure that the administration, overall management and operation of the home is undertaken in full compliance with the minimum operating requirements for such facilities specified in these Regulations. (2) The minimum operating requirements referred to in subregulation (1) above are– (a) that effective quality assurance and quality monitoring systems are in place to measure full compliance with these Regulations, the Act, and any other applicable laws, including but not limited to– (b) the provision and maintenance of a safe environment, which includes but is not limited to– (i) moving and handling; use of techniques for moving residents and objects that avoid injury to residents and staff; (ii) fire safety; Social Service Agencies 129 (iii) first aid; (iv) food hygiene; (v) infection control; (vi) general sanitation; (vii) potable water supply; (c) the observance of the Labour Act and other applicable law in the employment of providers, assistants and members of staff; (d) providing for the total care and supervision appropriate to each resident’s needs and capacity; (e) providing immediate medical attention and counselling to residents as is necessary; (f) maintaining an accurate staff/resident ratio as provided in the licence; (g) arranging for substitute staff members to be on call in case of emergencies; (h) providing access for providers, assistants and members of staff to training programmes focusing on geriatrics, elder abuse prevention, detection and reporting, basic social work principles and ethics, first aid and other related topics; (i) ensuring that all operators and managers receive a minimum of 6 hours of training per annum and all assistants and staff receive a minimum of 12 130 Social Service Agencies hours of training per annum to meet the specific needs of residents; (j) establishing a planned program of appropriate activities at the home for older persons to promote the social, emotional, intellectual, and physical health of each resident thereat, and individualizing each program where appropriate to meet the special needs of particular residents. Minimum staffing requirements. 6.–(1) Every operator registered and licensed under the Act shall employ persons who are in good physical and mental health, who have no history of abusive behaviour and who are professionally qualified to– (a) provide necessary care and support in assisting residents to adjust to living in a residential facility and accomplish goals outlined in their individual care or treatment plans; (b) relate and communicate well with adults. (2) Every operator registered and licensed under the Act shall, where possible, utilize the services of a social services practitioner. Minimum requirements for the protection of residents. 7.–(1) Every operator registered and licensed under the Act shall ensure that residents are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, inhuman or degrading treatment, whether through deliberate intent, negligence or ignorance, in accordance with subregulation (2). (2) The minimum requirements referred to in subregulation (1) above are– (a) that there be in place robust procedures for responding to suspicion or evidence of abuse or Social Service Agencies 131 neglect to ensure the safety and protection of residents; (b) that all allegations and incidents of abuse are followed up promptly and action taken is recorded; (c) that staff who may be unsuitable to work with vulnerable adults not be employed; (d) that the policies and practices of the home ensure that physical or verbal aggression by residents is understood and dealt with appropriately, and that physical intervention is used only as a last resort and in accordance with the law; (e) that the home policies and practices regarding residents’ money and financial affairs ensure residents access to their personal financial records, safe storage of money and valuables, consultation on finances in private, and that the policies preclude staff involvement in assisting in the making of or benefiting from residents’ wills. (3) Where an employee of a home for older persons becomes alerted to the signs of abuse, he shall make every effort to protect the resident from the abuse and shall take immediate action in response to the abuse including reporting it to the operator of the facility. (4) The operator of a home for older persons shall submit his staff to training adequate enough to be and remain in compliance with these Regulations. (5) The operator of a home for older persons shall develop a written procedural guideline or policy paper in respect of the procedure to be followed in the event of the occurrence of resident abuse, whether among themselves, or abuse committed by staff and 132 Social Service Agencies the procedural guidelines or policy paper shall be circulated among all staff. (6) The operator of a home for older persons shall develop polices which ensure that residents are safe from harm inflicted by staff and such policies shall concern the processing and monitoring of its staff, including volunteers, to ensure– (a) that no one alleged to have committed assault be employed at a home for older persons; (b) that there is an administrative system in place to check and document the background of probable employees, temporary staff, and volunteers; (c) that there is a reliable method to assess the suitability of potential staff to care for residents; (d) that all applicants present a police record; (e) that serious complaints against staff are dealt with in a manner that protects residents until investigations and disciplinary measures have been completed. (7) In addition to the minimum requirements specified in subregulation (2) above, every operator shall be required to report to the Registrar and to the Ministry for investigation, every case of actual or suspected abuse against residents which occurs at the home for older persons and which comes to his attention. Residents’ rights. 8.–(1) Every operator registered under these regulations shall ensure that policies and practices of the home uphold residents’ rights to a dignified existence, self-determination, communication with and access to persons and services inside and outside the facility. Social Service Agencies 133 (2) Among the policies and practices mentioned in subregulation (1) are included that– (a) every resident has the right to have his legal rights protected and to exercise his legal rights directly and participate in the civic process if he wishes; (b) no resident shall be coerced, discriminated against or suffer any reprisal from the home as a result of exercising his rights; (c) resident shall be allowed and facilitated to participate in the political process; (d) residents shall be informed verbally and, if necessary in writing, of their rights and the rules and regulations governing resident conduct and responsibilities during the time spent in the facility; (e) residents have the right to be fully informed, in a language that they understand, of their complete health status, including, but not limited to, their medical condition; (f) a resident has the right to refuse treatment. Residents’ funds. 9.–(1) Every operator registered under the Act shall ensure that policies and practices ensure that residents control their own money, except where residents expressly state that they do not wish to do so, or where they lack the legal capacity so to do, and that safeguards are in place to protect the interests of the residents. (2) The operator of a home for older persons shall allow residents to manage their own financial affairs, and the facility shall in no way coerce or attempt to coerce residents to deposit their personal funds with the facility. 134 Social Service Agencies (3) Upon written authorization or, verbal authorization in the presence of an independent witness, a facility shall hold, safeguard, manage, and account for the personal funds of a resident which has been deposited with the facility. (4) Where the money of an individual resident is handled, the manager or operator of the facility shall ensure that the personal allowances of the residents are not pooled together, and that appropriate records and receipts are kept. (5) The manager of a facility, or the operator, in the absence of a manager, may be appointed as agent for the resident only where no other individual is available. In any such case, the manager or operator, as the case may be– (a) ensures that the registration authority is notified; (b) ensures that records are kept of all incoming and outgoing payments; (c) ascertains whether the manager, or operator, as the case may be, is appointed for social security purposes. (6) The operator of a facility shall ensure the deposit, in an interest-bearing account that is separate from any of the facility’s operating accounts, of a resident’s personal funds which are in excess of $100, and the credit of all interest earned on the resident’s funds to that account. (7) The operator of a facility shall establish and maintain a system of accounting that assures a full, complete and separate accounting of each resident’s personal funds entrusted to the facility on the resident’s behalf and such system of accounting shall conform to established principles of accounting. Social Service Agencies 135 (8) The operator of a facility shall ensure that proper records and receipts are kept of possessions handed over by the residents for safe keeping. (9) Upon the death of a resident with a personal fund deposited with a facility, the operator of that facility must convey the resident’s funds along with a final accounting statement in respect of those funds within 30 days, to the individual authorized to handle the resident’s affairs. Minimum operating policies. 10. Every operator registered and licensed under the Act shall implement general operating policies to govern the administration and operation of the home for older persons, and such policies shall include, but shall not be limited to, the following areasSchedule. Form 1 and Form 2. (a) admission and discharge of residents into and from a home for older persons; (b) the schedule of the day-to-day activities at a home for older persons; (c) the keeping of the records of providers, assistants, support staff and residents; (d) the health and nutrition policies to be followed at a home for older persons; (e) the right of residents to practice their culture and religion; (f) contact with family members; (g) management of residents, providers, assistant and support staff living with HIV/AIDS; (h) code of conduct for providers, assistants and support staff; 136 Social Service Agencies (i) staff training and development policies; (j) the recruitment, screening, training and utilization of volunteers within a home for older persons; (k) procedures on the management of emergencies and disasters; (l) procedures on the management of crises; (m) the use of residents for publicity or promotional purposes; (n) grievance complaints by residents and staff; (o) any other relevant policy that would be appropriate to specialized populations, at the Ministry’s discretion, provided that it is in furtherance of the objects of the Act. 11.–(1) Every operator registered and licensed under the Act shall confidentially maintain in respect of each resident admitted to a home for older persons the forms, records and documentation specified in subregulation (2) below for a period of seven calendar years after discharge or death. (2) The forms referred to in subregulation (1) above areSchedule. Form II. (a) the statement of health of the resident upon admission, as set out in Form 3 of the Schedule to these Regulations; and annual health records; Schedule. Form IA. (b) the admission form, as set out in Form 1 of the Schedule to these Regulations; (c) a copy of a social inquiry report prepared by social services practitioners and reports prepared Social Service Agencies 137 by other professionals on the psycho-social disposition of the resident, where necessary; (d) documentation on the general progress of the resident while at a facility; Schedule. Form 4. (e) care plans, as set out in Form 4 of the Schedule to these Regulations; Schedule. Form 2. (f) copies of any discharge forms as set out in the Schedule to these Regulations; (g) an updated picture of each resident. (3) The operator of a facility shall maintain a policy allowing records of residents to follow residents when transferred from one home to another. (4) The operator of a facility shall confidentially maintain and keep, for at least seven calendar years, unless otherwise determined, records including– (a) financial records relating to operating costs, sources of income, financial plans, annual auditor’s reports prepared by a certified accountant who is not affiliated with the facility, and other similar information for a period of ten calendar years; (b) an admissions register for residents, a special incidence log which should be kept for the life of the home for older persons; (c) daily attendance register for managers, assistants and members of staff; (d) staff records relating to health, reference letters for employment purposes, qualification 138 Social Service Agencies information, terms of reference, contracts, police records, criminal checks, staff performance evaluations, application forms, and any other job-related correspondence; (e) menus and meals served at the home for older persons. (5) An operator of a home of older persons who fails to keep and maintain the records specified in this Regulation, or who fails to keep such records in a manner which reflects current activities at a home for older persons, or who fails to keep such records in an easily accessible place, commits an offence and is liable on summary conviction to a fine not exceeding five hundred dollars. Relationship of operator and families. 12. Every operator of a home for older persons shall provide each resident’s family or representative, as the case may be, with the following– (a) access and visitation, unless advised to the contrary by the resident or on doctor’s order for the preservation of the health and safety of the resident; (b) opportunities to discuss the resident’s needs, and the policies and programmes at the home for older persons; (c) where possible, consultation about major decisions that impact the resident’s care. General minimum requirements of the physical environment. 13.–(1) Every operator registered and licensed under the Act shall ensure that each home for older persons under his management and control has adequate space for reasonable mobility and recreational use by the residents and that it is a clean and safe environment. (2) Without prejudice to the generality of subregulation (1) above, every operator of a home for older persons registered under Social Service Agencies 139 the Act shall, at all times, comply with the minimum physical requirements specified in subregulation (3) below, and the design should be approved by the Central or Local Building Authority, as the case may be. (3) The minimum physical requirements referred to in subregulation (2) above mean– (a) that the facility and equipment shall be kept clean, in good repair, and free from hazardous materials; poisonous substances e.g. peeling paint that contains lead; (b) that the building and the facility on a whole, should be handicap-accessible, with no open stairwells, and stairs are to be equipped with railings and gates; (c) that the home provides recreational and dining space (communal space), apart from the resident’s private accommodation, and corridors and entranceways amounting to at least 45 square feet per resident; (d) that outdoor space is accessible by wheelchair bound residents as well as those with other mobility disabilities; (e) that lighting in communal rooms is adequately bright and positioned to facilitate activities; (f) that furnishing in communal rooms is of good quality and suitable for the range of interests and activities preferred by the residents; (g) that residents have access to all parts of communal and private space through the 140 Social Service Agencies provision of ramps and other equipment required to achieve this; (h) that grab rails and other aids are in place in corridors, bathrooms, communal areas and where necessary in resident’s private accommodation; (i) that doorways in communal spaces, bathrooms and other spaces to which wheelchair bound residents have access, have a clear opening of at least 33 inches; (j) that storage areas are provided for aids and equipment; (k) that bedrooms have direct access to an exit corridor; (l) that single bedrooms are at least 10 feet by 10 feet; (m) that shared bedrooms allow for at least 80 square feet per resident; (n) that single bedrooms with wheelchair users have at least 130 square feet of usable space; (o) that bedrooms have at least one window to the outside; (p) that room dimensions and layout ensure that there is adequate room on either side of the bed to enable reasonable access to care givers and any equipment necessary for the residents’ need; (q) that all living space have a minimum ceiling height of at least 8 feet. Social Service Agencies 141 (4) Every operator of a facility shall ensure that the buildings at the facility have– (a) lockable doors preventing unauthorized individuals from entering, as well as easily capable of being opened in the case of emergencies; (b) sufficient exits for evacuation purposes and fire safety; (c) screen against flies and mosquitoes; (d) floors made from material which is easy to clean; (e) proper ventilation and lights to ensure the health and comfort of the resident; (f) adequate water supply, for hygiene and drinking purposes, of a safe and sanitary quality from an approved source, as well as hot and cold running water; (g) a separate kitchen area; (h) a separate staff area; (i) reasonable storage space for materials and equipment; (j) electricity and safe electrical outlets; (k) safe and sanitary sewerage and drainage systems; and (l) a working telephone (where available) with emergency numbers posted in conspicuous places within the facility. 142 Social Service Agencies (5) Every operator of a home for older persons shall ensure that toilet and bathroom facilities in the building accommodate the number of residents at the home for older persons and such toilet and bathroom facilities shall have– (a) adequate toilet facilities designed to accommodate wheelchair users; (b) adequate grab bars and other features aimed at preventing accidents and injuries; (c) a toilet within close proximity to the bedroom of a resident; (d) adequate toilet facilities (at a minimum toilet and basin) installed in all new facilities and extensions. Infection control programme. 14. Every operator registered under the Act shall ensure that every home for older persons under his management and control establishes an infection control programme with the following– (a) that laundry facilities in new buildings are so sited that soiled articles, clothing and infected linens are not carried through areas or come in contact with areas where food is stored, prepared, cooked or eaten; (b) that hand-washing facilities are prominently sited in areas where infected materials or clinical waste are handled; (c) that water is available to essential areas when there is a loss of normal water supply; (d) that laundry floor finishes are resistant and readily cleanable; Social Service Agencies 143 (e) that policies and procedures for control of infection include the safe handling and disposal of clinal waste, dealing with spillages, provision of protective clothing and hand washing; (f) that the home has a sluicing facility; (g) that an effective pest control programme is maintained so that the building is free from pests and rodents. Provision of bedding facilities for rest. 15.–(1) In the absence of a resident’s own provision, furnishings for individual shall be provided by the operator of a home for older persons, at the minimum degree as follows– (a) clean, comfortable single bed at a suitable and safe height for residents; (b) bedding appropriate for the weather; (c) curtains; (d) a mirror; (e) overhead and bedside lighting; (f) comfortable seating for two; (g) drawers or an enclosed space for clothes; (h) that the bedroom floor is covered with non-skid and water-resistant materials; (i) that doors to bedrooms are fitted with locks suited for residents’ capabilities and which are accessible to staff in emergency situations; 144 Social Service Agencies (j) that residents are provided with keys to their rooms unless otherwise determined by families or management on the basis of the health and safety of the resident; (k) that residents have lockable storage space for medications, money and valuables and that they are provided with the keys unless otherwise determined by families or management on the basis of the health and safety of the resident; (l) that screening mechanisms are provided in share rooms to ensure privacy for personal care. Minimum programming requirements. 16.–(1) The operator of every home for older persons shall develop and implement a flexible written program plan composed of activities that meet and enhance the individual needs of its residents with different cultural, language, and special needs. (2) The program plan referred to in subregulations (1) above shall be available to families, staff members and the Ministry, and shall include– (a) indoor and outdoor physical activities; (b) creative experiences which allow residents opportunities to express their own ideas, feelings, and culture in all parts of the program; (c) a counselling program that utilizes individual and group techniques and addresses the counselling needs of residents; (d) experiences that promote self-reliance and self- esteem; Social Service Agencies 145 (e) health education that includes good health and nutrition practices, safety awareness including HIV/AIDS awareness; (f) any other program that may be needed to meet the needs of specialized populations. General health precautions to be observed by operators. 17.–(1) Every operator registered and licensed under the Act shall ensure that good health habits and practices are observed at the home for older persons and are incorporated into the written program plan. (2) The observance of good health and safety habits at the home for older persons shall, without prejudice to the operator’s overall responsibility therefor, as provided in subregulation (1) above, be the responsibility of providers, assistants, and members of staff and shall include– (a) that staff maintain the personal hygiene of each resident and, wherever possible, that staff support the residents’ own capacity for self-care; (b) that staff are trained to identify and assess those residents who have developed, or are at risk for developing, pressure sore; (c) that any incidence of pressure sores, their treatment and outcome, are recorded in the resident’s care plan and reviewed on a continuing basis; (d) that the resident’s psychological health is monitored regularly, and preventive and restorative care provided; (e) that opportunities are given for appropriate exercise and physical activity and appropriate 146 Social Service Agencies interventions are carried out for residents identified at risk for falling; (f) that nutritional screening is undertaken on admission and subsequently on a regular basis, and a record maintained of nutrition, including weight gain or loss, and appropriate action taken; (g) that residents have access to specialist medical, nursing, dental, pharmaceutical and therapeutic services and care from hospitals and health centres according to their need; (h) that residents have access to hearing and vision tests and appropriate aids (where available), according to their need; (i) that families or their designated representatives, where possible, are involved when addressing the health needs of the residents. Nutrition. 18.–(1) Every operator registered and licensed under the Act shall recognize that nutrition is very important to the wellbeing of older persons and shall provide nutritionally-balanced meals suited to individually assessed requirements. The meals shall include– (a) three full meals daily at not more than five-hour intervals; (b) that there is no more than 14 hours’ time lapse between a substantial evening meal and breakfast the following day; (c) that food is prepared by methods that conserve the nutritive value, flavour and appearance; Social Service Agencies 147 (d) that special therapeutic diets are provided when advised by health care staff, including adequate provision of calcium and vitamin D; (e) that religious or cultural diversity needs are taken into consideration when planning meals; (f) that the provider ensures that there is a menu which is changed regularly; (g) that food is procured from sources approved by the proper authority; (h) that food is stored, prepared, distributed and served under sanitary conditions. (2) All persons involved in the preparation of meals at or for homes for older persons shall observe good personal hygiene, foods sanitation practices, and be in possession of a valid food handler’s certificate issued by the proper authorities. (3) The operator of a home for older persons shall ensure that the facility is free from insects and rodents. 19. Every operator of a home for older persons shall disinfect on a regular basis, or wash at least once a week, the bedding materials of every resident in the facility. Cleanliness of bedding material to be maintained. 20.–(1) Every operator, assistant and staff members shall ensure that all residents observe good hygiene and body care practices. Personal appearance and hygiene. (2) Every operator, assistant and staff member shall ensure that residents are properly clothed. 21. Every operator shall ensure that each resident is allotted adequate space for the safe storage of personal articles. Personal articles. 148 Social Service Agencies 22. Animals may be kept only when the safety and health of both animals and residents can be ensured. Medical precautions and procedures. 23.–(1) Operators shall ensure that all residents get a full physical check up on an annual basis or as aften as recommended by a medical practitioner, and that the personal files of each resident contain complete medical information. (2) Facility operators should be aware of symptoms of common illnesses and be able to recognize them. Operators shall ensure that health and hygiene assessments are carried out on each resident and visits from the public health nurse should be encouraged whenever possible. (3) Assistants and staff must be in good health and take precautions to minimize the spread of infections. (4) An outbreak of any communicable disease shall be immediately reported to the public health authority and the Ministry. Medication and training. 24.–(1) Every operator of a home for older persons shall ensure that there is a policy governing the management of medication in that home and staff are required to adhere to procedures for the receipt, storage, handling, administration and disposal of medicines. (2) The policy shall entail– (a) that records are kept of all medicines received, administered or disposed of, in order to minimize the risk of mishandling; (b) that a record is kept of current medication for each resident; Social Service Agencies 149 (c) that where there is no resident medical practitioner, medicines shall be administered only by a trained staff. (3) Training includes– (i) a basic knowledge of how medicines are used and how to recognize and deal with problems in use; (ii) the principles behind all aspects of the home’s policy on medicine handling and records; (d) that the manager seeks information and advice from a registered pharmacist regarding medicine policies within the home and medicines dispensed for individuals in the home; (e) that staff monitor the condition of the resident on medication and call in the doctor if staff are concerned about any change in condition that may be as a result of the medication, and prompt the review of medication on a regular basis; (f) that when a resident dies, medicines should be retained for a few days in case the resident dies at home rather than in the hospital or in case there are any questions or investigations necessitating the relevant information on medications supplied to the resident; (g) that medicines shall be labelled clearly with the resident's name and instructions for use. First aid kit. 25.–(1) Every operator of a home for older persons shall ensure that all staff members are trained in basic first aid and cardio pulmonary resuscitation. A medical handbook shall be kept at the 150 Social Service Agencies facility for quick reference in case of accidents and other emergencies. (2) Every operator of a home for older persons shall ensure that each facility under his management and control have a well- equipped, accessible first aid kit. (3) In case of accidents, staff shall take immediate appropriate action to ensure the safety of each resident. All accidents should be documented and the operator and the Ministry with responsibility for older persons should be immediately notified of serious injuries. Minimum requirements for homes. 26.–(1) Every operator of a home for older persons registered under requirements of the Act shall provide services and activities to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident in accordance with a written care plan. (2) Every operator of a home for older persons shall– (a) ensure that the facility has sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by residents’ assessments and individual care plans; (b) develop for each resident a comprehensive care plan that includes measurable objectives and timetables to meet a resident’s medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. The care plan must be developed within 7 days after the completion of the comprehensive assessment and shall describe the services that are to be furnished; Social Service Agencies 151 (c) ensure that the care plan is periodically reviewed and revised by a team of qualified persons after each assessment; (d) prevent as much as possible the deterioration of a resident’s ability to perform routine activities of daily living; (e) provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming and personal hygiene; (f) ensure the residents receive proper treatment and assisted devices to maintain vision and hearing abilities; (g) take all reasonable precautions to ensure that residents do not develop pressure sores and, where a resident develops pressure sores, staff shall provide the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing; (h) ensure that the resident receives adequate supervision and assistive devices to prevent accidents; (i) ensure that a resident maintains acceptable parameters of nutritional status, such as body weight; (j) provide each resident with sufficient fluid intake to maintain proper hydration and health; (k) ensure that residents are free of any significant medication errors; 152 Social Service Agencies (l) care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life; (m) promote care of residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his individuality; (n) ensure that every resident has the right to choose activities, schedules, and health care consistent with his interests, assessments and care plan; (o) ensure that the medical care of each resident is supervised by a physician and must provide or arrange for physician services in case of an emergency; (p) provide pharmaceutical services (including procedures that assure the accurate acquisition, receipt, dispensing and administration of all drugs) to meet all needs of each resident; (q) maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete, accurately documented, readily accessible, and systematically organized; Schedule. Form 5. (r) report any special incident to the Ministry in Form 5 as set out in the Schedule to these Regulations. Minimum counselling requirements. 27. Every operator registered and licensed under the Act shall develop a counselling program to be administered within the home for older persons by a suitably qualified person, and that is designed to meet the individual and collective counselling needs of Social Service Agencies 153 the residents and shall employ mainstream individual and group counselling techniques. Death and dying. 28.–(1) Every operator registered and licensed under the Act shall ensure that appropriate care is given to residents who are dying, that their death is handled with dignity and propriety, and their spiritual needs, rites and functions observed, as much as possible. (2) The staff of a home for older persons shall ensure– (a) that residents receive appropriate attention including pain and distress management; (b) that every effort is made to maintain the privacy and dignity at all times of a resident who is dying. (c) that practical assistance and counselling are accessible if a resident wishes. (3) Every operator of a home for older persons shall ensure that policies and procedures for handling dying and death are in place and observed by staff. 29. Every operator registered and licensed under the Act shall provide a comprehensive written disaster management and emergency plan. The plan shall include provisions for both man- made and natural disasters and shall include evacuation plans. These plans shall be in compliance with national standards and a copy of the plans shall be filed with the Ministry no later than April 30th of each year. Disaster management. 30.–(1) Every operator registered and licensed under the Act shall provide a written fire safety plan whichFire precaution. (a) shall include all the fire-fighting equipment in the home for older persons including the location of such equipment; 154 Social Service Agencies (b) shall include the procedures to be followed in the event of a fire outbreak; (c) shall be posted in conspicuous places at the facility. (2) Every operator registered and licensed under the Act– (a) shall ensure that regular fire safety drills be conducted in each home for older persons under his management and control; (b) shall submit its fire safety plan for review by the National Fire Service on an annual basis. Crisis management. 31. Every operator registered and licensed under the Act shall provide a comprehensive written crisis management plan. The plan shall include provisions for appropriate intervention strategies, the immediate normalization of the situation, appropriate rehabilitation strategies for residents involved in the crisis and reporting procedures to the competent authorities. A copy of the plan shall be filed with the Ministry. Miscellaneous Offences and penalties. 32. Every person who contravenes any provision of these Regulations commits an offence and where no specific penalty is provided for such contravention, is notwithstanding anything to the contrary contained in the Interpretation Act, liable on summary conviction to a fine not exceeding one thousand five hundred dollars, or to imprisonment for a period not exceeding six months, or to both fine and imprisonment. Commencement. 33. These Regulations shall come into force on the 4th day of January, 2008. Social Service Agencies 155 MADE by the Minister of Human Development this 4th day of January, 2008. Minister of Human Development 156 Social Service Agencies (Regulation 10(a)) Resident’s Name: _____________________________________________ Date of Birth: ____________________ Age: __________ Date and Time of Admission: ______________________________ Brief Description of Resident’s Background/History: Has this resident been previously in a Home for Older Persons? _____ Yes _____ No _____ Unknown (✓ as appropriate) If yes, Name of Facility: _____________________________________________ Length of Stay: ____________________ Next of Kin or Authorized Representative: _________________________ Relationship: ________________________________________________ Address: ____________________________________________________ Name of Social Services Practitioner or Police Officer accompanying persons at the time of admission: _________________________________ Name of Social Services Practitioner with case responsibility: _________ Comments: __________________________________________________ Name and Signature Date Social Service Agencies 157 (Regulation 10(a)) To: ___________________________________________, (Name of Home for Older Persons) Resident’s Name: ____________________ Age: _____ Sex: _____ Caseworker: ____________________ Date: __________ The abovenamed resident is discharged from this facility. □ Will be returned on __________ before 6pm. (date) Responsibility for the general care of the older person during this time lies with the abovenamed person. □ Will be placed for the purposes of ____________________ and will not be returned. Authorized person of the Ministry 158 Social Service Agencies (Regulation 11(2)(a)) I, ___________________________________________, have examined (Physician/Public Health Nurse name) _____________________________________ with the following results: (Resident’s Name) Weight: __________ Pulse: __________ Blood pressure: __________ Temperature: __________ Heart: __________ Lungs: __________ General appearance and condition (cleanliness, skin rashes and discolorations, bloating, swelling, etc.) External signs of disease: External signs of injuries and their location (burns, lacerations, bruises, scratches) Other findings: _______________________________________________ Recommendations for follow-up treatment: Physician/Public Health Nurse Signature Date Social Service Agencies 159 (Regulation 11(2)(e)) Resident’s Name: _____________________________________________ Date of Birth: ________________________________________________ Date of Admission: ___________________________________________ Next of Kin: _________________________________________________ Contact information: __________________________________________ Respite Care/ Long term Plans: __________________________________ Goal Activities Time Frame Special Needs Dietary Needs Health Psycho-social: Recreation/ Physical Therapy Disability Issue 160 Social Service Agencies (Regulation 26(2)(r)) Name of Home: ______________________________________________ Date of Incident: _______________ Staff on duty at the time of the incident: ___________________________ Name and age of resident(s) involved in the incident: Detailed description of Incident: _________________________________ Action taken by staff on duty: ___________________________________ Was incident reported? _____ Yes _____ No (✓ as appropriate) If yes, Date: _______________ To whom: _____________________ Recommendations of staff on duty: _______________________________ Follow-up action needed: ______________________________________ Comments: __________________________________________________ Name and Signature of staff completing Date Form